New-Graduate Nurse Simulation Interventions with STEMI Patients to Build Competencies

Simulated clinical methods can help students shift from students to practitioners in ST-Elevation Myocardial Infarction (STEMI). Hence it is essential to look into how simulation can help this transition. Simulation training should include debriefings and a group known as INACSL (International Association of Clinical Simulation and Learning). Because it helps students comprehend what, how, and why they are learning, debriefing is a crucial part of the learning process. Observational knowledge is a critical component of STEMI in high-fidelity simulations. It is frequently cited as a desirable and necessary step in learning consolidation and transfer. Learning Simulation Interventions with STEMI Patients helps students strengthen their interpersonal skills and ethical frameworks and work through challenging scenarios.

Besides making sure their students understand examples and approaches, healthcare educators want them to think critically about them, make conclusions, and provide creative solutions to clinical problems. Simulated training and debriefing must be incorporated into the educational process to employ STEMI as an educational supplement. Debriefings, rather than lectures, are often regarded as a reflective learning strategy that allows students to explore how a new topic is applied to their prior knowledge. Incorporating technology into the classroom is beneficial and has better patient outcomes. Nursing students who participate in STEMI exercises improve their skills, including recognizing geriatric patients, effectively triaging emergencies, caring for patients, and working cooperatively in an obstetrics context. Simulator-based approaches to healthcare teaching are not yet conclusive but will influence how nurses use simulation models with STEMI Patients. New graduate nurses' communication and evaluation abilities during their first six months of nursing practice may be affected by their participation in simulation-based training exercises, or not.

Synthesis of the Literature

Before the advent of online learning, graduate nurses were trained in classrooms, research laboratories, or at the patient's bedside, where they could immediately put their new abilities into practice. A growing body of research points to the need for creative methods of teaching future nurses how to perform high-fidelity evaluations, think critically and communicate with colleagues from various disciplines (Mamun & Alouani, 2020). Patients and learners benefit from using a patient simulator instead of traditional training techniques. Students can hone their clinical skills while studying in a safe environment (Xu & Yang, 2020). More research is needed on the competency level of newly graduated nurses who have done simulation training because of the abundance of evidence-based and anecdotal accounts. As acuity levels among hospital patients rise, nurses become increasingly underprepared to work successfully in complex clinical conditions.

The reality of the learning environment and equipment

Participation in roleplaying in simulation-based tests has improved STEMI Patients' critical thinking, self-efficacy, and communication skills. Efficacy is a person's faith in their abilities, regardless of the circumstances. Self-efficacy can be increased by practicing and mastering a craft (Huber & Quinn, 2018). Using high-fidelity simulation situations, critical thinking skills may be taught to STEMI nurses, helping them develop positive habits such as self-assurance, a context-sensitive point of view, inventiveness, adaptability, and a sense of wonder (Bakracheski et al., 2020). It is then time to figure out how the most effective learning methods and experiences might be incorporated into nursing practice.

Staffing and equipment costs are worth STEMI students' self-confidence

To see if novice nurses are better prepared to care for STEMI patients, Hooda & Sweeny (2021) switch from traditional classroom instruction to simulation-based training. STEMI simulation-based training has been called into question by academics who fear it may decrease the transfer of skills from the classroom to clinical practice. Research on how simulation labs might be used to improve education is needed in light of these and other factors. In rural or remote places where emergency treatment is provided, Landi et al. (2022) feel STEMI simulation-based instruction is necessary. A mobile education unit was used to simulate classroom instruction for the objectives of this research. These facilities can be used for up to seven days for training in obstetrics, surgery, and combat trauma.

Staffing and equipment costs are worth students' learning outcomes

Multiple STEMI patient simulation was used in a recent randomized trial to examine novice nurses' ability to make decisions and follow up on patients, recognize changes in their status and interpret assessment data, take the initiative, work independently, and complete tasks within specified time frames, anticipate risk and delegate tasks, and keep track of all these things. Movahed et al. (2022) employed PowerPoint voice-overs, professional modeling, and reading assignments to gather data. The American Nurses Association and the National League for Nursing support this technology in nursing simulation training. In terms of data collection, the two raters at both study sites were almost perfectly on the same page, according to the kappa statistic (Tabl, 2020). Comparing changes from baseline in competent behavioral performance between the three groups revealed no statistically significant differences. The number of simulations increased significantly before and after group dissolution (Braeschke et al., 2019). Overall performance improved dramatically over time no matter what training was used. Students who participate in simulation models with STEMI Patients gain first-hand knowledge of how priorities are set and distributed (Khaire, 2020). Typically, each nurse in a hospital unit is accountable for at least two patients. This can be advantageous if responsibilities are appropriately assigned.

Summary of the Literature

The high-stakes simulation models with STEMI Patients suggest that rater training may be uneven, biased, and lacking in impartiality. This holds accurate even when dealing with more difficult abilities or situations. A landmark Movahed et al. (2022) study stressed the need to utilize valid and reliable foundations to assess practice success and competency. The findings of this study are consistent with those of that study. Researchers working in rater training must evaluate the competency of the raters and agree on the necessity for a shared mental model of expected performance behaviors in a simulation scenario to be successful.

Concerning the PICOT, a consistent set of assessment instruments used by experienced clinical observers is essential to uncover best practices to improve STEMI students' academic, educational, and professional outcomes. This is the largest and most comprehensive study for undergraduate nursing students interested in substituting simulation-based learning for traditional clinical training.

Intervention and Evaluation Plan

Objectives

A short-term goal is to deliver and implement a system that explains the PICOT issue and predicts the expected conclusion. Students' conceptual schemata for a particular idea are enhanced when they are reminded of what they learned in a single week of instruction. STEMI has been intended to be exceptionally flexible to accommodate a wide range of participants with varying degrees of expertise and experience. As a long-term goal, the initiative aims to aid nursing educators in reinforcing the unique learning requirements of nursing students who fall short of expectations in their courses. The program's attrition rate is expected to be reduced. The high-fidelity simulation could help nurses better comprehend their current and future practice options. Simulations in the classroom can help students improve their communication skills and prepare them for the clinical scenario. When a simulation is used to instruct students in an evidence-based skill or technique, the students can practice and receive feedback on their performance. Critical thinking skills can be fostered through simulation-based education.

Description of the Practicum Site and Stakeholders

Students attended weekly sessions designed to help them fill in gaps in their understanding. The University Campus served as the location for the practicum. Program implementation is intended to benefit students in the accelerated bachelor's program. Students from the School of Nursing are the primary stakeholders in this case. More robust knowledge of nursing ideas will be available to all students if professors have easy access to the interventions being taught on campus. Students benefit from using simulation laboratories to familiarize themselves with and grasp the intricacies of the hospital environment. Because of this, students can benefit from ongoing education in a learning environment that pushes their abilities while also allowing them to understand and improve therapeutic outcomes when approaches are standardized. It is feasible to assess and increase staff competence by using simulations. Talented students are more likely to adhere to established industry norms because they are more confident in their abilities. Simulator labs can help investigators find flaws in the current systems or practices that led to a fatal event, allowing for their correction.

Change Model

When in the nursing field, one needs to be up to date on the latest trends and developments. Thus, educational institutions face the difficulty of successfully regulating these changes in student enrollment. An institution's ability to respond quickly to shifting conditions is essential to stay abreast of current best practices. The ADKAR model is the best choice in this situation. In this method, the five steps are Awareness (desire), Knowledge (abilities), and Reinforcement (Awareness). Organizations that want to improve their ability to recognize and respond to change and get the best possible results must follow the model's five stages. There has been increasing use of the ADKAR model in clinical and academic contexts. An in-depth examination of its effects will necessitate additional investigation. Observing what students take away from the ADKAR model can help individuals learn from them. The use of simulation laboratories by nursing students is on the rise as an alternative to hands-on clinical training. Students in future nursing programs will have difficulty deciding on the most effective learning method. As soon as possible, a new policy must be implemented that includes clinical hours at the hospital and clinical practice hours in the ADKAR model. Shortly, there will be a need for more research into the future of simulation lab training and the creation of a standardized system of scenarios based on evidence and assessed for quality results. The rising use of simulation labs for continuing education and competency in the clinical setting necessitates policy changes.

 Implementation Plan

This project needs to be adjusted since first-semester nursing students cannot integrate concepts they have previously studied into their clinical experiences. A new teaching method being considered for implementation shortly involves holding weekly workshops in the classroom to reinforce critical concepts. Attending these sessions may benefit students who have fallen behind in understanding new nursing facts and ideas. Adopting the ADKAR Model of Change is essential to an organization's long-term change efforts, allowing it to succeed. If first-year nursing students in the baccalaureate nursing program fail to grasp the fundamentals of nursing, patient care and health outcomes may suffer in the future. Many students are unprepared to recognize and respond to their patients' health deterioration, even though cardiac arrest is the most common outcome. High-fidelity patient simulation has been proven to improve physical products when used for training in adult patient care. However, there is a lack of research on children in distress. Due to their role as first responders, students have an opportunity to affect their learning outcomes. Identifying and cultivating high-performance skills can be helpful in this area.

Evaluation

When planning interventions for nursing students at the end of their first semester, the project manager drew on the ADKAR Model of Change to help guide them. Evidence-based practice (EBP) and good memory of nursing concepts and theories are not linked in clinical simulations and assessments of students. It is expected that Miramar's nursing students will apply the ADKAR Model of Change in this project to help them enhance their academic and professional performance while completing their degrees. Students can practice responding to and coping with various circumstances in a realistic working environment without endangering the patient's safety. Deteriorating pediatric patients' clinical outcomes are heavily impacted by their students' belief in their abilities and the severity of their disease, which is compounded by their Awareness of their medical situation.  

Evaluation Results

Students could compare their summative assessment A performance to their first content reviewed test performance to see how well they retained the newly provided nursing ideas over the previous two weeks. They could also see how the weekly workshops that served as STEMI project reinforcement for the content they learned impacted their progress in the class. When the class's overall performance was compared to the results of their first summative assessment and their first content-based assessment, the initial evaluation was conducted.

The clinical skills and knowledge of nursing students were strengthened by participation in practical workshops that utilized a variety of instructional modalities. The first topic review exam results from this group of nursing students indicated that the weekly reinforcement sessions were a success. Despite his initial reluctance, this project manager's mentor was keen for her to record the class's overall performance before and after the reinforcement sessions when she asked about recording individual student performance in the type where she was working on her STEMI project.

The way students are educated in nursing schools is evolving along with the field itself. There are a lot of challenges that educational institutions must deal with, both academically and administratively. A constant reminder that progress is being made or that an organization's current style of conducting itself requires improvement is provided by the occurrence of the change. An essential part of the ADKAR transformation model focuses on a person's ability to change their state of mind based on their current state of knowledge and desire. Together, they help a firm realize its full potential so that the best outcomes can be part of the solution to find and resolve the recognized problem that calls for change. The project manager's case study shows that first-year nursing students cannot use the verbal and practical abilities previously taught in their STEMI Project. This scenario necessitates a shift in perspective. A weekly classroom workshop style is recommended as a teaching technique to ensure that students have the background information necessary to grasp new nursing concepts. Using the ADKAR Model of Change, companies may make changes more smoothly and consistently, boosting their chances of success by defying employee resistance for longer. Nursing students' academic performance and progress will be addressed in the STEMI Project, which aims to improve patient care and improve health outcomes in the long term.

After each weekly course, this project manager administered a two-question survey to participants to determine their level of satisfaction. The project manager gave students a pre-assessment before the simulation briefing. An after-simulation evaluation instrument was provided and collected immediately following the conclusion of the simulation briefing session. An evaluation tool was replaced with three questions that students answered during the pre-briefing part of the simulation, which was given to them after the simulation was done. Four nurse roles were needed for the simulated clinical environment established by this project manager and mentor.

First-year nursing students must understand the critical link between evidence-based practice and accurate recall of nursing concepts during evaluations and clinical simulations. Adopting the ADKAR Model of Change for this STEMI Project was essential to ensuring its success. This project manager considered the ADKAR Model of Change as a guide for implementing the planned interventions and evaluating their outcomes. Summative assessment A will be used to compare classroom performance with the initial test performance of content-reviewed students following exposure to the weekly workshops for this STEMI project.

Numerical and qualitative techniques measure the effectiveness of the STEMI project's weekly reinforcement of newly learned skills. Independent variables included a week-long workshop for first-semester nursing students focused on reinforcing recently discovered clinical reasoning skills in evidence-based practice in nursing. A comparison was made between students who chose to attend the weekly workshops to support information and those who did not to determine whether or not the workshops affected their academic and clinical outcomes. When the class's overall performance was compared to the results of their first summative assessment and their first content-based assessment, the initial evaluation was conducted. Students could compare their summative assessment performance to their first content reviewed test performance to see how well they retained the newly provided nursing ideas over the previous two weeks. They could also see how the weekly workshops that served as STEMI project reinforcement for the content they learned impacted their progress in the class.

Conclusion

There has been some discussion about using virtual simulations to help doctors better respond to patients who are not doing well. Reinforcement as a teaching method was examined in this project to see if it could help first-year nursing students better understand and retain new concepts. First-year nursing students in an accelerated nursing program took part in the study. Adult and pediatric patient simulations were used in a 16-hour training session for the treatment group. According to the implications of this project results for theory development, nurses who participate in STEMI can better identify patients in decline, have greater confidence in themselves, and are more knowledgeable of critical care procedures than nurses who do not participate in STEMI.

Throughout the studies, intervention and results confirmed the theory used in the intervention by evaluating the best way to treat an adult patient who was rapidly decompensating while waiting for a team of rapid response responders to get on the spot. Working in an interdisciplinary team and maintaining clear lines of communication in high-stress situations were both stressed during the training as part of the collaboration concept Simulations were prepared and implemented according to the International Nursing Association's Clinical Simulation and Learning Standards of Best Practice for Simulation Facilitation. The RRT was activated in all of the cases of STEMI.

This project's research question was, "Were patients treated with STEMI to resolve more difficult medical concerns?" A new body of knowledge about the advantages of using STEMI has been added, building on previous research and aiding team communication in dynamic contexts. Other teachers should implement this intervention because simulating a STEMI patient, finding RRT criteria, and developing communication skills with both patients and healthcare team members are the most valuable components of the experience.

References

Bakracheski, N., Mojsovska, V., & Kovaceska-Bashuroska, E. (2020). CRT-100.34 importance of organized STEMI network for the improvement of contact-to-Wire time and 30-Day mortality rate in STEMI patients. JACC: Cardiovascular Interventions, 13(4), S8-S9. https://doi.org/10.1016/j.jcin.2020.01.023

Braeschke, L., Braun, I., Kapp, F., & Hara, T. (2019). Integrate confidence ratings in audience response systems in order to help students to self-regulate their learning process. Proceedings of the 11th International Conference on Computer Supported Education. https://doi.org/10.5220/0007731404090415

Hooda, A., & Sweeny, J. (2021). Acute coronary syndrome: STEMI and Non-STEMI interventions. Practical Manual of Interventional Cardiology, 259-266. https://doi.org/10.1007/978-3-030-68538-6_20

Huber, K., & Quinn, T. (2018). Systems of care for patients with acute ST elevation myocardial infarction (STEMI networks). Oxford Medicine Online. https://doi.org/10.1093/med/9780199687039.003.0042_update_002

Khaire, D. U. (2020). Incidence of Cardiogenic shock in acute Stemi patients Thrombolysed with Streptokinse. Journal of Medical Science And clinical Research, 08(02). https://doi.org/10.18535/jmscr/v8i2.51

Landi, A., Gargiulo, G., & Valgimigli, M. (2022). The effects of Cangrelor on platelet aggregation in STEMI patients. JACC: Cardiovascular Interventions, 15(2), 229-230. https://doi.org/10.1016/j.jcin.2021.11.016

Mamun, M. M., & Alouani, A. (2020). Diagnosis of STEMI and Non-STEMI heart attack using nature-inspired swarm intelligence and deep learning techniques. Journal of Biomedical Engineering and Biosciences. https://doi.org/10.11159/jbeb.2020.001

Movahed, M. R., Hashemzadeh, M., & Movahed, M. R. (2022). CRT-100.06 the occurrence of ST elevation myocardial infarction (STEMI) and Non-STEMI in patients with post-traumatic stress disorder (PTSD) using the large nationwide inpatient sample (NIS). JACC: Cardiovascular Interventions, 15(4), S1-S2. https://doi.org/10.1016/j.jcin.2022.01.074

Tabl, M. A. (2020). CRT-100.31 safety of Ticagrelor post-fibrinolysis in STEMI patients. JACC: Cardiovascular Interventions, 13(4), S7. https://doi.org/10.1016/j.jcin.2020.01.020

Xu, J., & Yang, Y. (2020). Integrated gene expression profiling analysis reveals potential molecular mechanisms and candidate biomarkers for early risk stratification and prediction of STEMI and Post-STEMI heart failure patients. https://doi.org/10.21203/rs.3.rs-118025/v1 

Appendix A – Literature Sourcing Methods

Appendix B - The ADKAR model

Appendix C – Teaching Plan